Widespread concerns and complaints about the quality of nursing home care for persons with dementia are supported by findings from numerous government and non-government studies (as cited in Harris & Clauser, 2002). The Alzheimer's Association (2003) reports people with Alzheimer's disease (AD) and related dementias in nursing homes and assisted living centers require better quality care than they now receive. Quality care is also affected by turnover in U.S. workers providing direct, long-term care, for which cost estimates equal approximately $3,500 per employee-more than $4 billion a year (Seavey, 2004). The long- term goal of this Phase II is therefore to complete a series often interactive, online training and intervention modules utilizing the applicants' trademarked total-approach CARES-protocol, a step-by-step process designed to improve the quality of residential dementia care. Phase I accomplishments provide the foundation for the proposed three-year Phase II. Phase II aims are to complete the development of the four- module Phase I training prototype; produce and test six new training modules; conduct a nationwide pilot study of all ten training modules in anticipation of a follow-on study to investigate the effects of CARES training interventions on CMS quality care indicators; and analyze and report the data collected in the pilot study about knowledge gain, caregiving behavior, and staff turnover rates pre/post training. Project applicants hypothesize a significant increase in CNA knowledge as measured by pre- and post-tests. The evaluation design also enables exploratory research to examine the extent and nature of changes in CNA clinical behavior with dementia residents, the impact of CARES implementation on facilities' CMS quality care indicator scores, and the effect on rates of staff turnover among CNAs involved in the pilot study as measured by individual facility analysis. The project is highly relevant to the mission of the National Institute on Aging as well as to public health in general, because it has far-reaching implications for the training of nursing assistants and improvement of quality care as measured by the Centers for Medicare Services (CMS) quality care indicators. Additionally, implementation of the CARES protocol could significantly improve care for residents with dementia or AD by training CNAs in an intervention approach appropriate for any caregiving situation. [unreadable] [unreadable] [unreadable]